Indian pediatrics最新文献

Fifteen sick neonates were transported to higher-level neonatal intensive care units (NICUs) using specially equipped aircraft with trained medical teams. The median (Q1, Q3) one-way distance traveled (km) was 710 (689, 1224.5), and the median (Q1, Q3) transit time and airborne time were 6 (5.5, 7) and 1.25 (1.22, 2.15) hours, respectively. Thirteen neonates needed mechanical ventilation and five needed inotrope support during transit. The median (Q1, Q3) NICU stay was 20 (13.5, 35) days. Twelve neonates (80%) were discharged, two (13.3%) left against medical advice, and one died. Air ambulance is a feasible, effective, and safe mode of transportation of critically ill neonates in India.

Objective: To evaluate the effect of biologic therapy, school success, parental education and socioeconomic status on transition readiness of adolescent patients with juvenile idiopathic arthritis (JIA) and their parents.

Methods: This cross-sectional study enrolled adolescent patients with JIA from two pediatric clinics. Juvenile Arthritis Disease Activity Score was calculated, and Transition Readiness Assessment Questionnaire (TRAQ) was administered to the patients and their parents. Demographic and clinical data were collected.

Results: The study included 91 JIA patients (median age 15.32 years, range 11.58-18 years) and their parents; 36 had active disease. Biologic usage was significantly associated with transition readiness of children (P = 0.038) and their parents (P = 0.035). School success was associated with higher levels of transition readiness; TRAQ was significantly lower in observed groups with "good" school success compared to "very good" (P = 0.024; P = 0.002) and "excellent" (P = 0.010; P = 0.012). Parents' education or socioeconomic status has no influence on transition readiness.

Conclusion: Biologic usage and better school performance have a positive impact on the patients and their parents' transition readiness.

Objective: India has the highest number of stillbirths worldwide. However, the disease and economic burdens of stillbirths in India remain missing. This study aimed to estimate the disease and economic burden associated with stillbirths in India and its states for 2019.

Methods: A retrospective analysis was conducted using stillbirth data from the health management information system (HMIS) and civil and sample registration systems (CRS and SRS) for India and its states. Disease burden was calculated as disability-adjusted life years (DALYs) and economic burden as value of life years (VLYs). A sensitivity analysis for disease burden estimation was performed using a framework that estimated DALYs using a stillbirth-adjusted life expectancy.

Results: Indian HMIS reported 263,342 stillbirths in 2019. Nationally, stillbirths led to 18.3 million DALYs and a monetary loss of INR 7.80 trillion. Uttar Pradesh, Maharashtra, Rajasthan, Madhya Pradesh, Gujarat, and West Bengal contributed to more than 40% of the burden. The sensitivity analysis showed consistent findings.

Conclusion: Stillbirths should be prioritized in the public health agenda as they contribute to a high burden of disease and disability.

Objective: This study assessed the psychological distress, depression, and burden among primary caregivers of children with steroid-sensitive nephrotic syndrome (SSNS) and explored its association with disease severity and patient/caregiver demographics.

Methods: Psychological assessment of primary caregivers of children aged 6 months to 15 years with SSNS was performed using General Health Questionnaire-12 for psychological distress, Beck Depression Inventory for depression, and Zarit Burden Interview-6 for caregiver burden.

Results: Out of 72 eligible caregivers, 60 were included. Severe depression, severe psychological distress, and significant caregiver burden were observed in 38.3%, 30%, and 61.7% of primary caregivers, respectively. Steroid-dependent nephrotic syndrome (SDNS) and disease duration over 24 months increased severe psychological distress. Risk factors for caregiver depression included child < 7 years, female gender, frequently relapsing nephrotic syndrome (FRNS)/SDNS, steroid use > 6 months, > 4 relapses, and prior hospitalization. Caregiver burden was higher in younger age, FRNS/SDNS, hospitalization, and lower middle socio-economic status.

Conclusion: Caregivers of children with SSNS experience significant psychological distress, depression, and financial burden.

Objectives: Survivors of childhood cancer are at risk of sleep disturbances, an often, neglected aspect of holistic health. This study was carried out to determine the prevalence of sleep disturbances in survivors of pediatric acute lymphoblastic leukemia (ALL) and to identify any risk factors for the same.

Methods: Survivors of ALL aged 6-18 years, who had completed their treatment, at least two or more years ago, were enrolled. The Child Sleep Habits Questionnaire (CSHQ) was used to assess the sleep problems.

Results: Out of 89 childhood survivors of ALL, 42.7% had sleep disturbances. Fears during treatment, painful memories during treatment, younger age at enrolment, and shorter interval from treatment completion were significantly more in patients having sleep problems.

Conclusions: Approximately half of childhood ALL survivors had sleep problems. Fears during chemotherapy and shorter post-completion interval were significant risk factors for sleep problems in childhood cancer survivors.

Objective: To examine the association between the duration of intrapartum antibiotic exposure (IAE) and the risk of culture-negative early-onset neonatal sepsis (EONS) and any late-onset neonatal sepsis (LONS) in the first week.

Methods: Preterm neonates (≤ 34 weeks) were enrolled into: Group A (no IAE; n = 282), Group B (IAE < 24 h; n = 204) and Group C (IAE ≥ 24 h; n = 84). The risk factors for EONS and LONS were noted and all neonates were followed up for culture-negative EONS (primary outcome). Secondary outcomes included culture-positive EONS, culture-negative and culture-positive LONS, and multidrug-resistant sepsis. A univariable followed by multivariable analysis of risk factors to predict culture-negative EONS and LONS was performed. The cut-off (Youden's index) of IAE associated with various outcomes was determined.

Results: From group A through C, gestation and birth weight declined, and the proportion at risk of EONS increased. Culture-negative EONS incidence increased (9.57% vs. 12.74% vs. 36.90%, respectively, P_trends < 0.001), but its proportion among all EONS did not. Culture-positive LONS incidence declined (P_trends = 0.038). The proportion of culture-negative LONS among all LONS increased (P_trends = 0.024). Threshold values of 13.5 h and 4.5 h were associated with culture-negative EONS and culture-positive LONS in the first week, respectively. However, on adjusted analysis, IAE duration had no association with culture-negative EONS or LONS in the first week.

Conclusions: Duration of IAE is not independently associated with increased incidence of culture-negative EONS or any LONS.

Objective: To report the feasibility and safety of percutaneous device closure of patent ductus arteriosus (PDA) in preterm neonates from a tertiary center in Northern India.

Methods: A retrospective chart review of the clinical profile, nature of device used, and outcomes of inborn preterm neonates who underwent percutaneous device closure of PDA was conducted. The intervention was performed by experienced pediatric cardiologists using a transvenous approach under fluoroscopic guidance.

Results: Ten neonates with median (Q1, Q3) gestation of 29 (27, 30) weeks underwent device (Piccolo device) closure at a median (Q1, Q3) age of 37 (27, 41) days. At the time of procedure, the median (Q1, Q3) weight of the infants was 1270 (1120, 1890) g and the median (Q1, Q3) PDA diameter was 3.0 (2.3, 3.0) mm. Successful PDA closure was achieved in nine neonates; six showed clinical improvement. No procedure-related death was observed.

Conclusions: Percutaneous device closure of PDA in preterm neonates is safe and feasible.